Provider Demographics
NPI:1033565809
Name:YASER SHAHEEN D.M.D PLLC
Entity Type:Organization
Organization Name:YASER SHAHEEN D.M.D PLLC
Other - Org Name:MICHIGAN HEALTHY SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:313-918-5188
Mailing Address - Street 1:27115 NORTHMORE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3643
Mailing Address - Country:US
Mailing Address - Phone:313-918-5188
Mailing Address - Fax:
Practice Address - Street 1:5728 SCHAEFER RD STE 203
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2287
Practice Address - Country:US
Practice Address - Phone:313-769-5850
Practice Address - Fax:313-769-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021613261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental